Safety, Fear and Neuromuscular Responses after a Resisted Knee Extension Performed to Failure in Patients with Severe Haemophilia

Abstract

Background: low–moderate intensity strength training to failure increases strength and muscle hypertrophy in healthy people. However, no study assessed the safety and neuromuscular response of training to failure in people with severe haemophilia (PWH). The purpose of the study was to analyse neuromuscular responses, fear of movement, and possible adverse effects in PWH, after knee extensions to failure. Methods: twelve severe PWH in prophylactic treatment performed knee extensions until failure at an intensity of five on the Borg CR10 scale. Normalised values of amplitude (nRMS) and neuromuscular fatigue were determined using surface electromyography for the rectus femoris, vastus medialis, and vastus lateralis. After the exercise, participants were asked about their perceived change in fear of movement, and to report any possible adverse effects. Results: Patients reported no adverse effects or increased fear. The nRMS was maximal for all the muscles before failure, the median frequency decreased, and wavelet index increased during the repetitions. The vastus lateralis demonstrated a higher maximum nRMS threshold and earlier fatigue, albeit with a lower and more progressive overall fatigue. Conclusions: severe PWH with adequate prophylactic treatment can perform knee extensions to task failure using a moderate intensity, without increasing fear of movement, or adverse effects.

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“…These results are consistent with those reported by Tarata et al [ 30 ], who reported a drop after the beginning of the task, showing how the central intervention affects fatigue. Similarly, Calatayud et al [ 21 ] reported significant differences in low-load tasks. Three types of fatigue are described: central fatigue, neuromuscular junction fatigue, and muscle fatigue [ 31 ].…”

“…The median frequency is defined as the frequency that divides the power density spectrum in two regions with the same amount of power [ 29 ]. Median frequency variation (VMF) shows neuromuscular fatigue during the various repetitions in the vastus medialis [ 21 ]. According to our study, this value showed statistically significant changes between the two assessments.…”

“…Electrodes were placed according to the European recommendations for the use of surface electromyography [ 20 ]. Bipolar rectangular silver/silver chloride (Ag/AgCl) electrodes were used, measuring 28 × 44 mm (Ambu ® WhiteSensor 4200 model) with a 46 mm 2 measurement area, 2 cm apart [ 21 ]. For the patients to reach their maximum muscle strength, the rater provided the same verbal stimulus to motivate all the patients with each contraction.…”

“…Electrodes were placed following SENIAM recommendations [ 21 ]. To evaluate rectus femoris activation, the electrode was placed at 50% of the distance of the path that runs from the line between the anterosuperior iliac spine and the upper pole of the patella.…”

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“…29 Bipolar rectangular silver/silver chloride (Ag/AgCl) electrodes were used, measuring 28 × 44 mm (Ambu ® WhiteSensor 4200 model) with a 46 mm 2 measurement area, 2 cm apart. 30 All patients received the same verbal stimulus to obtain maximum muscle strength.…”